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A <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Three Twenty at the Cascade - Site Utilities Division B) <br />PROJECT NO 118-074D FINAL COST $53,487.00 <br />CONTRACT SIGNED 12/20/2018 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Installtion of sanitary sewer line and connection to Citv sewer, <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having been completed, <br />the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />of South Bend which were a part of the above Contract. <br />txecuted this 5th T of August 2019 Ritschard Bros., Inc. <br />I "I Company Name <br />8ignature 1204 W. Sample St. <br />-Rachelle L, Dolniak Company Address <br />Printed Name South Bend, IN 46619 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Rachelle L. Dolniak dacknowledged his/her signature to the above Project Completion Affidavit on <br />the 5 Y of Au Zt ,2019 <br />11111/, /// <br />Z�lu <br />Nok are My Commission Expires \Ap,RD <br />Robin v\ F()oz TA <br />Printed Name County of Residence St.:-:Jo8eph <br />If the Contractor is a corpora e following certificate will be executed. <br />J—, Donald Ritscb ar�Txl. ce fy that I am Secretary of the Corporation �644nq �Ilg <br />Rachola-e L �O no who signed this, release on behalf of the r-was4 <br />eat f said orporation; that said release was duly signed' are <br />Y, <br />by ion y f is �oveWrny, is within the scope of corporate powers: Corvat,` -0 it g d d is, <br />Corporate Seal <br />Donald Ritschard, Jr. <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable fry at approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />Construction ger <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Gary A. Gilot, President <br />10zMT0=?J=,TJr; in <br />Genevieve E. Miller, Member <br />Laura L. O'Sullivan, Member <br />Eftaboth A. Maradik, Member <br />'CWda M. Martin, Clerk <br />